We found a significant association between the PAI-1 4G/5G polymorphism and MetS risk in the overall population under allele (4G vs 5G, OR = 1.31, 95% CI = 1.04–1.64, P = .021), homozygous (4G/4G vs 5G/5G, OR = 1.71, 95% CI = 1.10–2.65, P = .016), and dominant model (4G/4G vs 4G/5G+5G/5G, OR = 1.41, 95% CI = 1.09–1.83, P = .009). Here, SERPINE1 is linked to metabolic syndrome.