Previous studies reported the correlation of PAI‐1 with multiple conventional risk factors of CHD, eg, obesity, glycemic traits, and type 2 diabetes mellitus,6 metabolic syndrome,7 as well as correlation with vessel wall thickness.8 In addition, higher PAI‐1 expression was observed in coronary artery tissues in the presence of atherogenic lesions.9, 10 These findings raise interest in whether PAI‐1 plays a role in early atherosclerosis versus acute thrombosis. This evidence concerns the gene SERPINE1 and obesity due to melanocortin 4 receptor deficiency.