Plasminogen activation inhibitor 1 inhibits plasminogen activation and leads to fibrinolysis and a pro-thrombotic state.19,20 PAI-1 is secreted more by visceral than subcutaneous fat21 and is also a risk factor for coronary artery disease (CAD),22 whereas angiotensinogen has been implicated in the aetiology of hypertension and is upregulated in obesity,23,24 with production being higher in visceral fat.25 Furthermore, angiotensinogen is the precursor of angiotensin II of the vasoconstriction renin–angiotensin system and may be a causal agent for the hypertension seen during obesity.26 This evidence concerns the gene SERPINE1 and obesity due to melanocortin 4 receptor deficiency.