Toronto, May 21 : In a growing list of studies on whether women are less prone to heart disease than men, fresh research of more than 160,000 people in 21 countries that was published in The Lancet has revealed that women are less likely than men to have cardiovascular disease (CVD) and die from it. According to the study, there have been concerns that women with CVD are managed less aggressively than men which could lead to women having poorer prognoses. Some have attributed this to a treatment bias against women. "In our global study, we observed that while prevention strategies were used more often by women, invasive strategies such as percutaneous coronary intervention and coronary artery bypass surgery was used more often for men," said study first author Marjan Walli-Attaei from McMaster University in Canada. "But, overall, outcomes such as death or a new heart attack or stroke in women were lower than in men. This suggests there may be factors other than a treatment bias against women that contribute to the treatment differences," Walli-Attaei added. It didn't matter if women had, or didn't have, a previous heart attack or stroke. It also didn't matter where they lived around the world and nor their economic status, the study said. The information came from the Prospective Urban Rural Epidemiological (PURE) study which followed the participants an average of 10 years. It is the first global study to document the risk factors, use of treatment, the incidence of heart attacks and strokes and mortality in people from the community, rather than just hospital patients. The findings showed that women with no history of cardiovascular disease (CVD) were more likely to use preventative medicines, control hypertension and to have quit smoking, compared to men. According to the researchers, the lower rates of invasive cardiac treatments of women with CVD could be partly explained by the fact that fewer women than men have the type of extensive atherosclerosis that requires medical interventions. "Other studies have reported that sex differences in invasive cardiac procedures are not seen once we consider the extent and severity of coronary artery disease," said study co-author Annika Rosengren. "This suggests that the lower rates of coronary interventions in women are appropriate as they have less extensive disease," she said. There is, however, substantial concern about the differences in treatment between poorer and richer countries. The differences in outcomes in both women and men in low-income countries, where approximately 40 per cent die within 30 days of a heart attack or stroke compared to the less than 10 per cent in high-income countries, is a matter of substantial concern, the researchers noted. Another research, published earlier this month in the Journal of the American Heart Association, found that men and women largely suffer the same heart attack symptoms. Investigating why heart disease generally develops later in women than men, another study published in journal Cardiovascular Research in 2017, demonstrated a link among female ovarian hormones, the circadian system which regulates the body's day-night cycle, and the observation that women enjoy significant protection against heart disease when compared to men. /IANS