Although anaesthesia itself is now very safe, perioperative cardiac complications during non-cardiovascular surgery are a major cause of morbidity and mortality, because of the increasingly high underlying prevalence of cardiovascular disease. Fortunately, although there is no "magic bullet", pharmacological intervention can reduce the risk. In particular, current evidence strongly supports the use of aspirin and statins. Beta blockers may also be beneficial in higher risk groups but need to be titrated to effect, and their use requires careful consideration because of adverse effects in these patients.