Patients with obesity, diabetes, hypertension, and CKD often exhibit elevated inflammatory cytokines (e.g., interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α), C-reactive protein (CRP)), endothelial activation, impaired nitric oxide signaling, and oxidative stress that promote ventricular stiffening [35,36,37,38,39]. Here, TNF is linked to diabetes mellitus.