This study demonstrated a considerably reduced plasma level of non-esterified
fatty acids (NEFA). In short, an increase in plasma NEFA level inflicts vascular dysfunction initiated by oxidative stress, which leads to hypoxia and hence
development towards pulmonary hypertension
(Avogaro et al., 2003; Sainsbury et al., 2004; Sarafidis and Bakris, 2007; Zoer et al., 2009).