Among the outcomes examined , the highest absolute risk increase was for heart failure .
Associations between atrial fibrillation and included outcomes were broadly consistent across subgroups and in sensitivity analyses .
Atrial fibrillation is associated with an increased risk of death and an increased risk of cardiovascular and renal disease .
OBJECTIVE To quantify the association between  atrial fibrillation and cardiovascular disease , renal disease , and death .
Late incidence and determinants of stroke after aortic and mitral valve replacement.
BACKGROUND Stroke is a devastating complication in patients with prosthetic valves , but characterization of its late occurrence from a large cohort is lacking . METHODS Three thous and one hundred eighty-nine adult patients who underwent a total of 3,576 operations for left-heart valve replacement  were managed with contemporary anticoagulation guidelines and prospect ively followed in a dedicated clinic . Total follow-up was 20,096 patient years . Bootstrapped survival analysis was used to determine the impact of patient and valve related factors on the incidence of stroke . RESULTS Most strokes were embolic . Linearized embolic stroke rates were 1.3 % + /- 0.2 % per year for aortic bioprostheses , 1.4 % + /- 0.2 % per year for aortic mechanical valves , 1.3 % + /- 0.3 % per year for mitral bioprostheses , and 2.3 % + /- 0.4 % per year for mitral mechanical valves ( p = 0.002 , vs other implant types ) . Age more than 75 years , female gender , and smoking were independent risk factors after aortic and mitral valve replacement . Atrial fibrillation , coronary disease , and tilting-disc mechanical prostheses were independent predictors of embolic stroke after aortic valve replacement . Preoperative left ventricular ( LV ) dysfunction was an independent risk factor in patients with mitral prostheses .  Primary operative indication , diabetes , redo status , or the presence of two prosthetic valves were not associated with an increased hazard . The addition of acetyl salicylic or dipyridamole to warfarin anticoagulation did not significantly lower embolic stroke risk in patients with mechanical prostheses . CONCLUSIONS Approximately 20 % of patients with valve prostheses have an embolic stroke by 15 years after valve replacement . Some risk factors such as the avoidance of smoking , mitral mechanical prostheses , aortic tilting-disc valves , and proceeding to mitral surgery before LV dysfunction occurs are potentially modifiable
Among the outcomes examined , the highest absolute risk increase was for heart failure .
Associations between atrial fibrillation and included outcomes were broadly consistent across subgroups and in sensitivity analyses .
Atrial fibrillation is associated with an increased risk of death and an increased risk of cardiovascular and renal disease .
OBJECTIVE To quantify the association between  atrial fibrillation and cardiovascular disease , renal disease , and death .