TNF and endothelial dysfunction: Inflammatory factors (e.g., CRP, TNF-α, and IL-6) will all be increased in IR state, and they can cause a direct injury to cardiomyocytes, thereby reducing myocardial function and exacerbating HF (8, 44, 45) IR may lead to endothelial dysfunction and increased permeability of the vascular wall, promote platelet aggregation and vasoconstriction, and ultimately result in vascular dysfunction and formation of atherosclerotic plaques (46).