CCL2 and obesity due to melanocortin 4 receptor deficiency: Metabolically, since myocardial and EAT depend on the same microvascular system, EAT in patients with obesity secrete a variety of adipokines including TNF-α, MCP-1, IL-6, IL-1β, fibrinogen activator inhibitor-1 (PAI-1), which can act directly on myocardial tissue through paracrine and vascular secretion, producing a proinflammatory state that promotes cardiomyocyte stiffness and coronary endothelial dysfunction (72).