Dr Mark Shulman is a member of the METS study investigation team whose work was published in the Lancet in 2018. Additionally he is the primary author of a recently published substudy addressing pre operative functional and biomarker assessment as it pertains to patient centred outcomes. In this podcast Mark outlines the findings of both studies to help the modern day perioperative physician negotiate the management of patients with a significant cardiac risk factor burden in this challenging phase of care.