Moreover, IR is associated with dysregulated activation of the renin–angiotensin–aldosterone system (RAAS) and elevated levels of plasminogen activator inhibitor-1 (PAI-1) that lead to dysfunction of the fibrinolytic system, as well as the development and progression of autonomic neuropathy, which could promote myocardial systolic and diastolic dysfunction or life-threatening arrhythmias [61,62,63]. This evidence concerns the gene SERPINE1 and autonomic neuropathy.