Secondly,elevated RBP4 in cardiac hypertrophy may have pathophysiological consequencesbecause RBP4 increased cell size, enhanced protein synthesis, and elevated theexpression of hypertrophic markers including NP precursor A (NPPA), NPPB genes,and Myh7 in primary cardiomyocytes by activating the TLR4/MyD88 pathway [32], andthe onset of heart failure is typically preceded by cardiomyocyte hypertrophy. This evidence concerns the gene TLR4 and cardiac hypertrophy.