Given the crucial role of IGFBP-3 in regulating IGF bioavailability and modulating cellular responses via IGF-independent mechanisms, it is plausible that IGFBP-3 may impact the development of PAH through similar pathways (Ranke, 2015; Fujimoto et al., 2019; Baxter, 2024). This evidence concerns the gene IGF1 and pulmonary arterial hypertension.