These changes concerning both structural and functional alterations are secondary to several mechanisms, as well as visceral fat distribution and related peptides secreted from epicardial adipose tissue (adipokines, angiotensin II, inflammatory cytokines); hyperinsulinemia and insulin resistance; elevated blood pressure behavior; and sleep apnea with its effect on nocturnal blood pressure, adrenergic stimulation, and chronic hypoxemia (36). This evidence concerns the gene AGT and hyperinsulinism.