Reducing Cardiometabolic Disease in Spinal Cord Injury Jochen Kressler, PhD a,b , Rachel E. Cowan, PhD a,b , Gregory E. Bigford, PhD a,b , Mark S. Nash, PhD a,b,c, * CARDIOMETABOLIC RISKS IN SCI Health hazards posed by all-cause cardiovascular disease (CVD) and co-morbid endocrine disorders are widely reported in persons with spinal cord injuries (SCI). 1–3 The contemporary descriptor cardiometabolic syndrome (CMS) represents a complex Supported by grants from the National Institute for Disability and Rehabilitation Research #H133G080150, the Craig H. Neilsen Foundation #124683, and the Congressionally Mandated Med- ical Research Program - United States Department of Defense #W81XWH-10-1-1044 (SC090095). a Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA; b The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA; c Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, 1500 North West 12th Avenue, Suite 1409, Miami, FL 33136, USA * Corresponding author. E-mail address: mnash@med.miami.edu KEYWORDS  Diet  Exercise  Behavioral modification  Drug therapy  Cardiometabolic syndrome  Spinal cord injuries KEY POINTS  Accelerated cardiometabolic disease is a serious health hazard after spinal cord injuries (SCI).  Lifestyle intervention with diet and exercise remains the cornerstone of effective cardio- metabolic syndrome (CMS) treatment.  Behavioral approaches enhance compliance and benefits derived from both diet and ex- ercise interventions and are necessary to assure that persons with SCI profit from intervention.  Multitherapy strategies will likely be needed to control challenging component risks, such as gain in body mass, which has far reaching implications for maintenance of daily func- tion as well as health.  In cases where lifestyle approaches prove inadequate for risk management, pharmaco- logic control is now available through a population-tested monotherapy.  Use of these clinical pathways will foster a more effective health-centered culture for stakeholders with SCI and their health care professionals. Phys Med Rehabil Clin N Am 25 (2014) 573–604 http://dx.doi.org/10.1016/j.pmr.2014.04.006 pmr.theclinics.com 1047-9651/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.