TNF and heart failure: The authors suggest that inflammatory biomarkers in heart failure (HF), such as IL-6, TNF-α, and C-reactive protein, have a direct impact and influence the onset of osteosarcopenia by reducing IGF-1 levels and branched-chain amino acids. Oxidative stress activates the UPS system, promoting protein degradation. Additionally, low testosterone levels induced by HF also play a role.