Yet another study warns you to keep your cool if you want to live longer.University of North Carolina researchers have new evidence that uncontrolled anger is a threat to health and life. People who rank highest in answers to a questionnaire assessing feelings of anger are nearly three times more likely to have a heart attack or suffer sudden cardiac death than those who are least anger-prone, a group led by Janice E. Williams, a research fellow at the university, reports in the May 2 issue of Circulation: Journal of the American Heart Association.It's one more link in the chain between anger and ill effects on health, Williams says. "There have been at least two other studies showing the same relationship," she says. "One was the Framingham Heart Study, which looked at suppressed anger and heart disease, and the other was done at the Harvard School of Public Health."In the new study, Williams and her colleagues analyzed data on nearly 13,000 participants in the Atherosclerosis Risk in Community trial. Their anger was measured by answers to the 10 questions in the Spielberger Trait Anger Scale. It asks whether an individual is hot-headed, whether he or she wants to hit someone when angered, whether there are feelings of great annoyance when no recognition is given for good work, and more of the like.Of the people in the study, 8%, or 1,000 persons, ranked highest on the scale. In the six-year follow-up period, they were 2.69 times more likely to have a heart attack or suffer sudden death than those lowest on the scale. Individuals with moderate feelings of anger were 35% more likely to experience a coronary event.And while the angriest people were more likely to be cigarette smokers, the higher risk persisted even when smoking and other risk factors, such as diabetes, overweight, and high cholesterol levels, were taken into account, Williams says."There has always been a suspicion that emotional states such as anger, nxiety, and depression have an impact on health," she says. "Now we're better able to document the association with the use of follow-up studies such as this one."Where's the anger management?But unhappily, while the health dangers of anger are well established, "to my knowledge there are no studies that focused on giving people anger-management skills and show that that in turn reduces the incidence of heart attacks," says Jerry Deffenbacher, professor of psychology at Colorado State University.Nevertheless, Deffenbacher says, controlling anger can do no harm to health and can help personal relationships, and "there are things that people can do to lower anger and manage it efficiently."Control starts with self-awareness, he says: "A lot of emotional behavior is on automatic pilot. People who react angrily may not be good observers of what triggers their anger. You can start looking for patterns, consistent internal and external triggers."One effective tactic in an anger-provoking situation is "to learn to take time out," Deffenbacher says. "When you know you're ready to jump, you might go for a walk, avoid confrontation for the next few minutes until you calm down. A time-out can be a very powerful tool."Can a friend, relative, or spouse help by pointing out an anger problem? "Only if the person is ready to listen," Deffenbacher says. Without that readiness, he says, "it may fall on deaf ears or denying ears."If self-control doesn't work, professional counseling may help, but "unfortunately, the treatment of anger is way behind the treatment of other problems, such as anxiety and depression," he says. "We're just beginning to develop intervention strategies."But counseling, perhaps coupled with drugs for anxiety, can produce positive results for many people, Deffenbacher says.