Cardiovascular disease has been the leading cause of death in the United States for the past 50 years (1) and is the predominant concern in the preoperative assessment of the adult patient undergoing noncardiac surgery. Rates of perioperative cardiovascular complications range from 0.4% to 11%; an incidence of 2% was observed in an unselected population over age 50 (2). The number of perioperative cardiac events ranges from 500,000 to 900,000 per year (3). With urological surgery, cardiac mortality is on the order of 0.3%, accounting for just under one-fourth of all-cause mortality (4). However, the risk of cardiovascular complications is not fixed, and can be reduced by perioperative and intraoperative interventions (5), such as careful preoperative assessment and planning. In this review, we discuss the principles of preoperative cardiovascular assessment and care with special emphasis on the patient undergoing urologic procedures and surgery.