Conversely, IGFBP-4 associates with LRP5/6 when Wnt ligands are present, inhibiting the Wnt/β-catenin signaling pathway activation, which serves as a safeguard against ischemic injury to the myocardium.38 IH interferes with normal endothelial cells and can disrupt endothelial cell homeostasis, potentially leading to endothelial dysfunction. This evidence concerns the gene IGFBP4 and endothelial dysfunction.