SERPINE1 and chronic obstructive pulmonary disease: Insulin resistance is associated with dysregulated neurohumoral activation of the renin–angiotensin–aldosterone system, fibrinolytic dysfunction via increased plasminogen activator inhibitor-1 (PAI-1) levels, cardiac autonomic neuropathy, which may promote the development of systolic and diastolic dysfunction or cardiac arrhythmias, endothelial dysfunction, and subsequent hypertension [10–13].