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There are no clinically relevant tools to easily identify CVD risk in adults with spinal cord injury (SCI), despite CVD being an established long-term complication of SCI. Our objectives were to (1) determine prevalence of metabolic syndrome (MetS) in this population using four published definitions and to compare this to prevalence in the general population (GP), and (2) develop a more sensitive definition of MetS for the SCI population. 38 community-dwelling men with SCI to date have participated in a cross-sectional study in which fasting lipids, insulin, glucose, C-reactive protein and anthropometric data were measured. MetS prevalence was determined using World Health Organization (WHO), National Cholesterol Education Program (NCEP), National Heart, Lung and Blood Institute / American Heart Association (NHLBI/AHA) and International Diabetes Federation (IDF) definitions. Agreement between definitions ranged from kappa values of-0.54 (WHO and IDF, NS) to 0.72 (NCEP and NHLBI, P<0.001). Prevalence of MetS ranged from 2.8% (WHO) to 21.1% (IDF) in SCI subjects and 13.2% (NHLBI/AHA) to 30.0% (IDF) in GP. Data collection and analysis are underway to develop a more sensitive MetS definition for this population. Most current MetS definitions are in fair to poor agreement and likely underestimate MetS prevalence in the SCI population relative to GP. [ABSTRACT FROM AUTHOR]