{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:16:17Z","timestamp":1791317777836,"version":"4.3.1"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T00:00:00Z","timestamp":1775433600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":59,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Periodontitis is a common chronic inflammatory disease that has been increasingly linked to systemic conditions, including cardiovascular disease (CVD). The inflammatory burden and bacterial dissemination associated with periodontitis may contribute to atherosclerosis and cardiovascular events. However, evidence from clinical retrospective cohorts in Chinese populations remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study was conducted at the Baoying Traditional Chinese Medicine Hospital between January 2021 and December 2022. A total of 472 adult patients were included. Clinical and demographic data, periodontal parameters, and cardiovascular histories were collected from hospital records. Patients were classified according to the presence or absence of periodontitis. The prevalence of cardiovascular diseases\u2014including coronary artery disease, myocardial infarction, and stroke\u2014was compared between groups. Multivariate logistic regression and stratified subgroup analyses were performed to identify independent associations between periodontitis and cardiovascular outcomes, adjusting for potential confounders such as age, sex, smoking status, diabetes, and body mass index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 472 patients, 289 (61.2%) had clinically confirmed periodontitis, while 183 (38.8%) did not. The prevalence of cardiovascular disease was significantly higher in the periodontitis group compared with controls (38.7% vs. 21.3%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Multivariate logistic regression revealed that periodontitis was independently associated with increased risk of cardiovascular disease (adjusted OR\u2009=\u20091.87, 95% CI: 1.28\u20132.72,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001), even after adjustment for traditional risk factors. Additional predictors included age\u2009\u2265\u200960 years, smoking history, and diabetes. Additional severity-stratified analyses suggested that the association with cardiovascular disease was stronger in patients with stage III\/IV and grade C periodontitis than in those with milder disease.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This retrospective study found a significant association between periodontitis and cardiovascular disease after adjustment for conventional risk factors. These findings support the relevance of periodontal health in comprehensive cardiovascular risk assessment, although prospective studies are needed to clarify causality and the potential impact of periodontal treatment on cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-026-08282-x","type":"journal-article","created":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T10:05:20Z","timestamp":1775469920000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association between periodontitis and cardiovascular disease: a retrospective analysis"],"prefix":"10.1186","volume":"26","author":[{"given":"Yi","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baojun","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,6]]},"reference":[{"issue":"3","key":"8282_CR1","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.tcm.2019.05.001","volume":"30","author":"V Bucciarelli","year":"2020","unstructured":"Bucciarelli V, Caterino AL, Bianco F, Caputi CG, Salerni S, Sciomer S, et al. Depression and cardiovascular disease: The deep blue sea of women\u2019s heart. Trends Cardiovasc Med. 2020;30(3):170\u20136.","journal-title":"Trends Cardiovasc Med"},{"issue":"1","key":"8282_CR2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.31083\/j.rcm2301017","volume":"23","author":"PJ Nestel","year":"2022","unstructured":"Nestel PJ, Mori TA. Dietary patterns, dietary nutrients and cardiovascular disease. Rev Cardiovasc Med. 2022;23(1):17.","journal-title":"Rev Cardiovasc Med"},{"issue":"4","key":"8282_CR3","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1038\/s41569-018-0119-4","volume":"16","author":"D Zhao","year":"2019","unstructured":"Zhao D, Liu J, Wang M, Zhang X, Zhou M. Epidemiology of cardiovascular disease in China: current features and implications. Nat reviews Cardiol. 2019;16(4):203\u201312.","journal-title":"Nat reviews Cardiol"},{"issue":"12","key":"8282_CR4","doi-asserted-by":"publisher","first-page":"100146","DOI":"10.1016\/j.mocell.2024.100146","volume":"47","author":"JY Kim","year":"2024","unstructured":"Kim JY, Lee K, Lee MG, Kim SJ. Periodontitis and atherosclerotic cardiovascular disease. Mol Cells. 2024;47(12):100146.","journal-title":"Mol Cells"},{"issue":"7","key":"8282_CR5","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1007\/s11883-020-00848-6","volume":"22","author":"A Priyamvara","year":"2020","unstructured":"Priyamvara A, Dey AK, Bandyopadhyay D, Katikineni V, Zaghlol R, Basyal B, et al. Periodontal Inflammation and the Risk of Cardiovascular Disease. Curr Atheroscler Rep. 2020;22(7):28.","journal-title":"Curr Atheroscler Rep"},{"issue":"3","key":"8282_CR6","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/jcpe.13189","volume":"47","author":"M Sanz","year":"2020","unstructured":"Sanz M, Del Marco A, Jepsen S, Gonzalez-Juanatey JR, D\u2019Aiuto F, Bouchard P, et al. Periodontitis and cardiovascular diseases: Consensus report. J Clin Periodontol. 2020;47(3):268\u201388.","journal-title":"J Clin Periodontol"},{"issue":"supp1 1","key":"8282_CR7","doi-asserted-by":"publisher","first-page":"e026","DOI":"10.1590\/1807-3107bor-2020.vol34.0026","volume":"34","author":"RG Fischer","year":"2020","unstructured":"Fischer RG, Lira Junior R, Retamal-Valdes B, Figueiredo LC, Malheiros Z, Stewart B, et al. Periodontal disease and its impact on general health in Latin America. Section V: Treatment of periodontitis. Brazilian oral Res. 2020;34(supp1 1):e026.","journal-title":"Brazilian oral Res"},{"issue":"1","key":"8282_CR8","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1111\/prd.12484","volume":"92","author":"K Jepsen","year":"2023","unstructured":"Jepsen K, Sculean A, Jepsen S. Complications and treatment errors involving periodontal tissues related to orthodontic therapy. Periodontol 2000. 2023;92(1):135\u201358.","journal-title":"Periodontol 2000"},{"issue":"6","key":"8282_CR9","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1111\/idj.12630","volume":"71","author":"T Kwon","year":"2021","unstructured":"Kwon T, Lamster IB, Levin L. Current Concepts in the Management of Periodontitis. Int Dent J. 2021;71(6):462\u201376.","journal-title":"Int Dent J"},{"key":"8282_CR10","doi-asserted-by":"crossref","unstructured":"Altabas V, Bilo\u0161 LSK. The Role of Endothelial Progenitor Cells in Atherosclerosis and Impact of Anti-Lipemic Treatments on Endothelial Repair. Int J Mol Sci. 2022;23(5).","DOI":"10.3390\/ijms23052663"},{"issue":"1","key":"8282_CR11","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1038\/s41392-022-00955-7","volume":"7","author":"P Kong","year":"2022","unstructured":"Kong P, Cui ZY, Huang XF, Zhang DD, Guo RJ, Han M. Inflammation and atherosclerosis: signaling pathways and therapeutic intervention. Signal Transduct Target therapy. 2022;7(1):131.","journal-title":"Signal Transduct Target therapy"},{"issue":"8","key":"8282_CR12","doi-asserted-by":"publisher","first-page":"1656","DOI":"10.1093\/cvr\/cvad076","volume":"119","author":"X Wang","year":"2023","unstructured":"Wang X, Shen Y, Shang M, Liu X, Munn LL. Endothelial mechanobiology in atherosclerosis. Cardiovascular Res. 2023;119(8):1656\u201375.","journal-title":"Cardiovascular Res"},{"issue":"11","key":"8282_CR13","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1016\/j.hlc.2018.05.102","volume":"27","author":"EF Carrizales-Sep\u00falveda","year":"2018","unstructured":"Carrizales-Sep\u00falveda EF, Ordaz-Far\u00edas A, Vera-Pineda R, Flores-Ram\u00edrez R. Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease. Heart Lung Circ. 2018;27(11):1327\u201334.","journal-title":"Heart Lung Circ"},{"issue":"1","key":"8282_CR14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5334\/gh.400","volume":"15","author":"M Sanz","year":"2020","unstructured":"Sanz M, Del Castillo AM, Jepsen S, Gonzalez-Juanatey JR, D\u2019Aiuto F, Bouchard P, et al. Periodontitis and Cardiovascular Diseases. Consensus Rep Global heart. 2020;15(1):1.","journal-title":"Consensus Rep Global heart"},{"issue":"4","key":"8282_CR15","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.amjmed.2023.11.022","volume":"137","author":"S Hopkins","year":"2024","unstructured":"Hopkins S, Gajagowni S, Qadeer Y, Wang Z, Virani SS, Meurman JH, et al. Oral Health and Cardiovascular Disease. Am J Med. 2024;137(4):304\u20137.","journal-title":"Am J Med"},{"key":"8282_CR16","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1016\/j.biopha.2018.01.146","volume":"99","author":"Y Zhang","year":"2018","unstructured":"Zhang Y, Wang X, Li H, Ni C, Du Z, Yan F. Human oral microbiota and its modulation for oral health. Biomed Pharmacother. 2018;99:883\u201393.","journal-title":"Biomed Pharmacother"},{"issue":"7","key":"8282_CR17","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1177\/0022034520986097","volume":"100","author":"HJ Cho","year":"2021","unstructured":"Cho HJ, Shin MS, Song Y, Park SK, Park SM, Kim HD. Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study. J Dent Res. 2021;100(7):706\u201313.","journal-title":"J Dent Res"},{"issue":"9","key":"8282_CR18","doi-asserted-by":"publisher","first-page":"e0290545","DOI":"10.1371\/journal.pone.0290545","volume":"18","author":"X Guo","year":"2023","unstructured":"Guo X, Li X, Liao C, Feng X, He T. Periodontal disease and subsequent risk of cardiovascular outcome and all-cause mortality: A meta-analysis of prospective studies. PLoS ONE. 2023;18(9):e0290545.","journal-title":"PLoS ONE"},{"issue":"10","key":"8282_CR19","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1177\/0022034518765735","volume":"97","author":"E Nordendahl","year":"2018","unstructured":"Nordendahl E, Gustafsson A, Norhammar A, N\u00e4sman P, Ryd\u00e9n L, Kjellstr\u00f6m B. Severe Periodontitis Is Associated with Myocardial Infarction in Females. J Dent Res. 2018;97(10):1114\u201321.","journal-title":"J Dent Res"},{"issue":"4","key":"8282_CR20","first-page":"229","volume":"25","author":"J Ainamo","year":"1975","unstructured":"Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J. 1975;25(4):229\u201335.","journal-title":"Int Dent J"},{"key":"8282_CR21","doi-asserted-by":"publisher","first-page":"121","DOI":"10.3109\/00016356408993968","volume":"22","author":"J Silness","year":"1964","unstructured":"Silness J, Loe H. Periodontal disease in pregnancy. II. correlation between oral hygiene and periodontal condtion. Acta Odontol Scand. 1964;22:121\u201335.","journal-title":"Acta Odontol Scand"},{"issue":"Suppl 20","key":"8282_CR22","first-page":"S149","volume":"45","author":"MS Tonetti","year":"2018","unstructured":"Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Clin Periodontol. 2018;45(Suppl 20):S149\u201361.","journal-title":"J Clin Periodontol"},{"issue":"1","key":"8282_CR23","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1186\/s12903-024-04907-1","volume":"24","author":"HI Arbildo-Vega","year":"2024","unstructured":"Arbildo-Vega HI, Cruzado-Oliva FH, Coronel-Zubiate FT, Meza-M\u00e1laga JM, Luj\u00e1n-Valencia SA, Luj\u00e1n-Urviola E, et al. Periodontal disease and cardiovascular disease: umbrella review. BMC Oral Health. 2024;24(1):1308.","journal-title":"BMC Oral Health"},{"key":"8282_CR24","doi-asserted-by":"crossref","unstructured":"Liccardo D, Cannavo A, Spagnuolo G, Ferrara N, Cittadini A, Rengo C, et al. Periodontal Disease: A Risk Factor for Diabetes and Cardiovascular Disease. Int J Mol Sci. 2019;20(6).","DOI":"10.3390\/ijms20061414"},{"issue":"2","key":"8282_CR25","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1016\/j.atherosclerosis.2015.04.819","volume":"241","author":"G Aarabi","year":"2015","unstructured":"Aarabi G, Eberhard J, Reissmann DR, Heydecke G, Seedorf U. Interaction between periodontal disease and atherosclerotic vascular disease\u2013Fact or fiction? Atherosclerosis. 2015;241(2):555\u201360.","journal-title":"Atherosclerosis"},{"issue":"1","key":"8282_CR26","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/j.yexmp.2016.01.006","volume":"100","author":"DA Chistiakov","year":"2016","unstructured":"Chistiakov DA, Orekhov AN, Bobryshev YV. Links between atherosclerotic and periodontal disease. Exp Mol Pathol. 2016;100(1):220\u201335.","journal-title":"Exp Mol Pathol"},{"issue":"4","key":"8282_CR27","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/S0020-6539(20)33890-9","volume":"59","author":"A Blaizot","year":"2009","unstructured":"Blaizot A, Vergnes JN, Nuwwareh S, Amar J, Sixou M. Periodontal diseases and cardiovascular events: meta-analysis of observational studies. Int Dent J. 2009;59(4):197\u2013209.","journal-title":"Int Dent J"},{"issue":"5","key":"8282_CR28","first-page":"852","volume":"57","author":"P Cao","year":"2025","unstructured":"Cao P, Luan Q. [Periodontitis and systemic diseases: Thinking and explorations]. Beijing Da Xue Xue Bao Yi Xue Ban. 2025;57(5):852\u20138.","journal-title":"Beijing Da Xue Xue Bao Yi Xue Ban"},{"issue":"6","key":"8282_CR29","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1111\/jcpe.13807","volume":"50","author":"D Herrera","year":"2023","unstructured":"Herrera D, Sanz M, Shapira L, Brotons C, Chapple I, Frese T, et al. Association between periodontal diseases and cardiovascular diseases, diabetes and respiratory diseases: Consensus report of the Joint Workshop by the European Federation of Periodontology (EFP) and the European arm of the World Organization of Family Doctors (WONCA Europe). J Clin Periodontol. 2023;50(6):819\u201341.","journal-title":"J Clin Periodontol"},{"issue":"3","key":"8282_CR30","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1002\/JPER.19-0441","volume":"92","author":"TE Van Dyke","year":"2021","unstructured":"Van Dyke TE, Kholy KE, Ishai A, Takx RAP, Mezue K, Abohashem SM, et al. Inflammation of the periodontium associates with risk of future cardiovascular events. J Periodontol. 2021;92(3):348\u201358.","journal-title":"J Periodontol"},{"issue":"1","key":"8282_CR31","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/nri3785","volume":"15","author":"G Hajishengallis","year":"2015","unstructured":"Hajishengallis G. Periodontitis: from microbial immune subversion to systemic inflammation. Nat Rev Immunol. 2015;15(1):30\u201344.","journal-title":"Nat Rev Immunol"},{"issue":"16","key":"8282_CR32","doi-asserted-by":"publisher","first-page":"12861","DOI":"10.3390\/ijms241612861","volume":"24","author":"X Huang","year":"2023","unstructured":"Huang X, Xie M, Lu X, Mei F, Song W, Liu Y, et al. The Roles of Periodontal Bacteria in Atherosclerosis. Int J Mol Sci. 2023;24(16):12861.","journal-title":"Int J Mol Sci"},{"issue":"11","key":"8282_CR33","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1111\/jcpe.12771","volume":"44","author":"M Brousseau-Nault","year":"2017","unstructured":"Brousseau-Nault M, Kizhakkedathu JN, Kim H. Chronic periodontitis is associated with platelet factor 4 (PF4) secretion: A pilot study. J Clin Periodontol. 2017;44(11):1101\u201311.","journal-title":"J Clin Periodontol"},{"issue":"9","key":"8282_CR34","doi-asserted-by":"publisher","first-page":"e0308793","DOI":"10.1371\/journal.pone.0308793","volume":"19","author":"J Lyu","year":"2024","unstructured":"Lyu J, Zhang Y, Zhou R, Ding C, Ye H, Fang Q, et al. The effect of periodontal treatments on endothelial function in degrees of periodontitis patients: A systematic review and meta-analysis. PLoS ONE. 2024;19(9):e0308793.","journal-title":"PLoS ONE"},{"issue":"1","key":"8282_CR35","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.atherosclerosis.2014.06.002","volume":"236","author":"M Orlandi","year":"2014","unstructured":"Orlandi M, Suvan J, Petrie A, Donos N, Masi S, Hingorani A, et al. Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: a systematic review and meta-analysis. Atherosclerosis. 2014;236(1):39\u201346.","journal-title":"Atherosclerosis"},{"issue":"4","key":"8282_CR36","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1002\/JPER.24-0422","volume":"96","author":"A Polizzi","year":"2025","unstructured":"Polizzi A, Nibali L, Tartaglia GM, Isola G. Impact of nonsurgical periodontal treatment on arterial stiffness outcomes related to endothelial dysfunction: A systematic review and meta-analysis. J Periodontol. 2025;96(4):330\u201345.","journal-title":"J Periodontol"},{"key":"8282_CR37","doi-asserted-by":"publisher","first-page":"105511","DOI":"10.1016\/j.phrs.2021.105511","volume":"166","author":"S Sharma","year":"2021","unstructured":"Sharma S, Sridhar S, McIntosh A, Messow CM, Aguilera EM, Del Pinto R, et al. Periodontal therapy and treatment of hypertension-alternative to the pharmacological approach. A systematic review and meta-analysis. Pharmacol Res. 2021;166:105511.","journal-title":"Pharmacol Res"},{"issue":"1","key":"8282_CR38","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1111\/jcpe.12171","volume":"41","author":"WJ Teeuw","year":"2014","unstructured":"Teeuw WJ, Slot DE, Susanto H, Gerdes VE, Abbas F, D\u2019Aiuto F, et al. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol. 2014;41(1):70\u20139.","journal-title":"J Clin Periodontol"},{"issue":"4","key":"8282_CR39","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1111\/jcpe.13435","volume":"48","author":"N Marouf","year":"2021","unstructured":"Marouf N, Cai W, Said KN, Daas H, Diab H, Chinta VR, et al. Association between periodontitis and severity of COVID-19 infection: A case-control study. J Clin Periodontol. 2021;48(4):483\u201391.","journal-title":"J Clin Periodontol"},{"issue":"8","key":"8282_CR40","first-page":"1070","volume":"9","author":"R Andreu","year":"2021","unstructured":"Andreu R, Santos-Del-Riego S, Payri F. Serum Inflammatory and Prooxidant Marker Levels in Different Periodontal Disease Stages. Healthc (Basel). 2021;9(8):1070.","journal-title":"Healthc (Basel)"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12903-026-08282-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-08282-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-026-08282-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T21:32:02Z","timestamp":1781645522000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12903-026-08282-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,6]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["8282"],"URL":"https:\/\/doi.org\/10.1186\/s12903-026-08282-x","relation":{},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,6]]},"assertion":[{"value":"11 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Ethics Committee of Baoying Traditional Chinese Medicine Hospital (Approval No. 202413579514) and was conducted in accordance with the Declaration of Helsinki. Given the retrospective design of the study and the use of anonymized medical records, the requirement for informed consent to participate was waived by the Institutional Ethics Committee of Baoying Traditional Chinese Medicine Hospital.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"955"}}