In persons with chronic SCI (> 1 year), cardiovascular disease (CVD) is a leading cause of mortality, as it is in the general population. Compared to the general population, CVD-related morbidity in persons with SCI, specifically CAD, occurs earlier in life and is more prevalent. Based on this knowledge, the need for appropriate risk stratification in SCI population becomes apparent. Existing tools do not take into account specific consequences of SCI, possibly underestimating the actual risk for CVD. For example, most of the risk factor algorithms incorporate HDL cholesterol into their equations to determine CAD risk, with a cutoff level of HDL cholesterol below which the general population is at a heightened risk for disease. Such an approach does not factor in the severity of depression of HDL cholesterol. It is appreciated that the morbidity risk ratio for CAD in men rises above unity at an HDL cholesterol <40 mg/dL, and the risk continues to rise in a linear fashion as the values for the lipid moiety decrease. In individuals with SCI, HDL cholesterol levels may be markedly depressed, with higher, more complete lesions having the lowest values. Thus, individuals with SCI will have additional risk for CAD based on extremely depressed values of HDL cholesterol that are not captured by conventional categorization. In addition, higher cord lesions (above thoracic level six) are frequently hypotensive, activating the renin-angiotensin axis in an attempt to maintain normotension. Elevated levels of angiotension are appreciated be atherogenic. Once again, this pathophysiologic condition—that is, hypotension and elevated angiotensin levels— is not captured by conventional risk factor paradigms. Because of these considerations, as well as the extreme immobilization of SCI that may independently confer additional CAD risk, the use of conventional risk assessment tools in this population is fraught with obvious difficulty and potential error. For years, the need for development of new non-conventional assessment tools has been recognized in the able-bodied population, and the need for a more reliable vehicle to identify individuals at heightened risk is even more the case in individuals with SCI.