In patients with poor functional capacity or significant risk factors or symptoms (such as moderate-to-severe angina pectoris,decompensated heart failure（HF）, valvular disease,and significant arrhythmia), referral for cardiac work-up and optimization is recommended prior to elective surgery for peripheral artery disease（PAD） or abdominal aortic aneurysm（AAA）.(Evidence: Level C，Recommendation: Class Ⅰ)

Routine referral for cardiac work-up, coronary angiography,or cardiopulmonary exercise testing（CPET） prior to elective surgery for peripheral artery disease（PAD） or abdominal aortic aneurysm(AAA) is not recommended.(Evidence: Level C，Recommendation: Class III)

Preoperative carotid artery and cerebral imaging is recommended in patients with a history of transient ischaemic attack(TIA) or stroke in the previous 6 months and who have not undergone ipsilateral revascularization.(Evidence: Level C，Recommendation: Class Ⅰ)

For patients with carotid artery disease undergoing non-cardiac surgery(NCS),the same indications for carotid revascularization should be considered as for other patients with carotid stenosis.(Evidence: Level C，Recommendation: Class IIa)

Preoperative carotid artery imaging is not recommended routinely in patients undergoing non-cardiac surgery(NCS).(Evidence: Level C，Recommendation: Class III)

In patients with renal disease requiring peri-operative contrast-enhanced radiography, balanced hydration with i.v. isotonic fluids, the use of a minimal volume of contrast media, and the use of low-osmolar or iso-osmolar contrast media should be considered.(Evidence: Level B，Recommendation: Class IIa)

In patients with known risk factors (age .65 years, BMI .30 kg/m2, diabetes, hypertension, hyperlipidaemia, CV disease, or smoking) undergoing intermediate- or high-risk NCS, it is recommended to screen for pre-operative renal disease by measuring serum creatinine and GFR.(Evidence: Level C，Recommendation: Class Ⅰ)

If a cystatin C measurement assay is available, cystatin C measurement should be considered in patients with impaired eGFR (,45–59 mL/min/ 1.73 m2) to confirm kidney disease.(Evidence: Level C，Recommendation: Class IIa)

It is recommended to assess cardiorespiratory fitness to estimate peri-operative CV risk in obese patients, with particular attention to those undergoing intermediate- and high-risk NCS.(Evidence: Level B，Recommendation: Class I)

In patients at high risk of obesity hypoventilation syndrome, additional specialist investigation before major elective NCS should be considered.(Evidence: Level C，Recommendation: Class IIa)