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Aging is one reason

The first cardiovascular study of NNMT enzyme inhibition in a heart failure with preserved ejection fraction (HFpEF) mouse model demonstrated that treatment markedly reduced 1-MNA (by 77.1%), 2PY (by 66.2%), and 4PY (by 71.1%) in cardiac tissue, while improving cardiac function, enhancing global longitudinal strain, reversing peak longitudinal strain rate, and significantly reducing left ventricular hypertrophy and fibrosis

It has also been linked to FAK-paxillin pathway activation relevant to tissue migration

A physician's note signed at the end of a clinic session documents what happened at the start

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