Heightened risks for all-cause cardiovascular diseases (CVD) are widely reported in persons with spinal cord injuries (SCI). These risks occur earlier in life, develop silently, and are defined by fasting and non-fasting dyslipidemias, vascular inflammation, and other archetypical CVD hazards. Fasting studies typically show depressed levels of cardioprotective high-density lipoprotein cholesterol (HDL), and less often elevated total cholesterol and low-density lipoprotein cholesterol. Low HDL is especially revealing, as it typically foretells low fitness levels. Post-prandial risks for hypertriglyceridemia have also been reported after SCI, and may also be associated with sedentary lifestyle. Reduction of this risk is important for decreasing feeding-induced vascular inflammation. Both cross-sectional and prospective studies support exercise conditioning in effective treatment of SCI-associated dyslipidemia. Acute exercise, not longitudinal conditioning, however, better treats post-prandial CVD risks. The latter evidence may require a change in the exercise conditioning paradigms for those with SCI. Risks of CVD must be better understood and effective exercise interventions adopted, if best health, life quality and longevity are to be preserved.