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Patients with HFpEF have a particularly elevated level of leptin, which is associated with better outcome in HFrEF but not in HFpEF120 (neither on decompensated HF admission nor in New York Heart Failure Association [NYHA] class).92 Adiponectin Adiponectin is an adipokine implicated in energy metabolism, increasing insulin sensitivity and beta-oxidation and reducing gluconeogenesis ( Table 3 ).121 In chronic HF patients, adiponectin is considered to be a marker of catabolic state and disease progression, and low body fat is associated with higher levels of adiponectin.122 Beyond metabolic control, adiponectin has been linked to a cardiovascular risk profile (insulin resistance, arteriosclerosis and inflammation).123 In experimental models, adiponectin deficiency leads to hypertension, LV hypertrophy and diastolic dysfunction

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31 Environmental carcinogens are ubiquitous in the modern industrial world and pose a hazard to public health