Perioperative cardiac complications are frequently associated with non-cardiac surgery, particularly with major vascular surgery. Because major vascular surgery is high-risk surgery, patients scheduled for aortic surgery, such as those affected by thoraco-abdominal aortic aneurysm, must be investigated to quantify the cardiac risk. Obviously, when surgery is urgent, surgical repair is the priority and the patient cannot be further investigated in order to evaluate a specific risk stratification, or adequately treated to improve the clinical conditions. When surgery is not urgent, a preoperative evaluation of the patient’s risk-factors is recommended. The risk stratification allows optimization of the perioperative management and identification and determination, when possible, of the strategy to reduce the cardiac risk and to improve the outcome. Among the several medical therapies proposed to reduce the cardiac risk in non-cardiac surgery, the use of beta-blockers and statins has been extensively studied and it is recommended in high-risk surgery patients.