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01.
arXiv (CS.LG) 2026-06-18

GrapNet: A Programmable Dynamic-Architecture Neural Graph Substrate

作者:

arXiv:2606.18923v1 Announce Type: new Abstract: Programmability is a missing first-class interface in fixed-tensor neural networks: editing a relation, freezing a subgraph, auditing a local function, or changing the execution backend should be an operation on the neural program rather than ad-hoc parameter surgery. GrapNet studies this graph-as-network setting. The graph is the architecture and executable program, not an input data graph. Each compute node owns its next-layer child references and a trainable allocation vector aligned with those references; deleting a relation physically removes both the child reference and the corresponding allocation coordinate. Structural rules and execution policies live outside the node core, so the same child-owned graph can be grown, frozen, structurally edited, grouped into trainable family blocks, routed by attention over active relations, or lowered to dense snapshots after topology stabilizes. GrapNet composes with conventional modules through a vector-valued parent interface: dense layers, CNN encoders, ResNet feature extractors, attention blocks, and transformer representations can all feed one sensory GrapNode per coordinate. The evaluation is organized as a programmability stress suite rather than as a new replay benchmark. In a matched ten-seed Split Fashion-MNIST study, a plastic GrapNet+ER head reaches 63.16 percent seen-class accuracy versus 51.08 percent for a parameter-larger dense MLP+ER under the same seen-class loss and replay memory, with paired delta 12.08 points and p=1.3e-5. On Split CIFAR-10 with a frozen ImageNet ResNet-18 encoder, the same substrate improves the online head over MLP-256 by 3.81 points, with p=0.0026. These results support GrapNet as an editable neural graph substrate whose core value is structural programmability with faithful execution views.

02.
medRxiv (Medicine) 2026-06-18

Comparative Evaluation of Pretrained Large Language Models for Suicide Risk Prediction from Clinical Notes in U.S. Veterans

Background: Suicide remains a significant and potentially preventable cause of death among United States veterans. Predictive models based on structured electronic health record (EHR) data, including the U.S. Department of Veterans Affairs' Recovery Engagement and Coordination for Health-Veterans Enhanced Treatment (REACH-VET) program, aim to identify individuals at elevated risk for enhanced monitoring and follow-up. Increasing evidence suggests that unstructured clinical narratives contain additional psychosocial information that may enhance risk prediction when analyzed using natural language processing (NLP). However, optimal approaches for representing clinical text remain uncertain. Recent advances in large language models (LLMs) enable contextual text representations that capture complex semantic relationships beyond traditional lexical methods. Methods: We compared the predictive performance of pretrained LLMs with classical bag-of-words (BoW) representations for suicide risk prediction using clinical notes from 27,241 veterans receiving care in the Veterans Health Administration. Patients were stratified by REACH-VET risk tier (low, moderate, high), and models were evaluated across prediction windows defined by note look-back periods (

04.
arXiv (CS.LG) 2026-06-15

Robin-Neumann Coupling of PINN and FEM Solvers: A Steklov-Poincaré View, with Application to Fluid-Structure Interaction with Contact

arXiv:2606.14181v1 Announce Type: cross Abstract: Physics-informed neural networks (PINNs) are meshless and carry moving geometry and topology change through resampling of collocation points; the finite-element method (FEM) is the workhorse for boundary-fitted discretisations. Coupling the two across a shared interface promises the best of both, yet existing PINN-FEM schemes are validated only empirically. We put the coupling on a domain-decomposition footing: viewing each solver as a Steklov-Poincaré (trace-to-flux) operator, we transfer the classical Dirichlet-Neumann (DN) divergence diagnosis and its Robin-Neumann (RN) cure, including a closed-form, sweep-free interface impedance, and prove a PINN-specific contraction theorem: a trained network realises only a perturbed Steklov operator with a per-step training residual, and RN still contracts, with no shared-eigenbasis hypothesis, to a floor set by the achieved training loss. Because a PINN has no stiffness matrix, we introduce a Fourier-mode interface probe that recovers the network's resolvable Steklov eigenvalues to within 0.5% and doubles as a diagnostic of the network's spectral cap. The theory predicts measured PINN-FEM contraction rates to within 7% on 1D and 2D Poisson couplings, and a two-slab analogue of the large-added-mass regime shows RN's per-mode impedance matching winning decisively where tuned scalar relaxation saturates. We demonstrate the framework on a Stokes/rigid-disc problem with Alart-Curnier contact: the meshless PINN fluid absorbs the topology change at contact by collocation exclusion alone, no remeshing and no cut cells, and the static-equilibrium contact reaction matches the submerged weight to 0.4% under mesh refinement. We quantify remaining limitations: the warm-started PINN drifts off the Stokes manifold over long horizons, and matched FEM-FEM benchmarks attribute pre-impact squeeze-film signatures to PINN under-resolution.

06.
arXiv (CS.CL) 2026-06-19

Benchmarking Local LLMs for Natural-Language-to-SQL Querying in Biopharmaceutical Manufacturing: An Empirical Benchmark on Consumer-Grade Hardware

Biopharmaceutical manufacturing organizations operate under regulatory frameworks such as FDA guidance, EU Good Manufacturing Practice (GMP), and the EU AI Act, which can restrict the use of cloud-based artificial intelligence systems. Locally deployed large language models (LLMs) offer a privacy-preserving alternative, but their suitability for pharmaceutical manufacturing tasks remains underexplored. This study evaluates four open-source LLMs (Qwen 2.5 Coder 7B, Llama 3.1 8B, Mistral 7B, and Meditron 7B) deployed locally via Ollama for natural-language-to-SQL generation over a pharmaceutical manufacturing database. A FastAPI-based evaluation platform, PharmaBatchDB AI, was developed using a synthetic Microsoft SQL Server database containing approximately 63,000 records across Batch, Manufacturing Execution System (MES), and Clean-In-Place (CIP) modules. Models were benchmarked on 60 domain-specific natural-language questions using metrics including SQL extraction rate, SQL compliance, factual consistency, ROUGE-L, hallucination rate, throughput, and latency. Qwen 2.5 Coder 7B, Llama 3.1 8B, and Mistral 7B generated SQL for all evaluation tasks, while Meditron 7B failed on nearly all tasks due to context-window limitations and poor SQL generation capability. Llama 3.1 8B achieved the highest SQL compliance, whereas Qwen 2.5 Coder 7B achieved the strongest overall text similarity and factual consistency. Performance differences between the two leading models were not statistically significant. The results show that code-tuned general-purpose LLMs outperform a domain-specific biomedical model on structured query generation for pharmaceutical manufacturing data. Although fully local, GxP-aligned NLQ systems are feasible on consumer hardware, current performance levels still require human oversight and downstream validation for regulated use.

07.
arXiv (CS.AI) 2026-06-18

RTSGameBench: An RTS Benchmark for Strategic Reasoning by Vision-Language Models

arXiv:2606.18950v1 Announce Type: new Abstract: Modern Vision-Language Models (VLMs) often struggle with strategic reasoning, i.e., anticipating and influencing other agents' actions, under uncertainty in competitive and cooperative settings. Real-time strategy (RTS) games can be a natural testbed for diagnosing this limitation, as they demand coordination with allies, adaptation to opponents' strategy, and long-horizon planning under partial observability. However, existing RTS benchmarks offer limited evaluation scope, lack systematic competency diagnosis, and remain fixed in the pre-designed scenario coverage. To address these limitations, we present RTSGameBench, which is built on Beyond All Reason, a large-scale RTS game with an expanded battlefield that demands broader strategy diversity than the existing testbeds. The proposed benchmark provides evaluations through diverse gameplay across various matchup structures, diagnostic assessment via mini-games, each targeting an individual strategic competency, and extensible coverage via a self-evolving generation framework that converts free-form queries into new mini-games, improving over successive cycles. Additionally, for VLMs to operate in large-scale RTS games, we provide RTSGameAgent that manages units by an FSM with agentic memory. We empirically validate that multiple state-of-the-art VLMs do not perform well when matchups demand tighter coordination, multiagent coordination and when task scale increases.

08.
arXiv (quant-ph) 2026-06-17

Probing PbTe-Pb nanowire devices with radio-frequency reflectometry

arXiv:2606.04544v2 Announce Type: replace-cross Abstract: We report the implementation of radio-frequency (rf) reflectometry on selective-area-grown PbTe-Pb nanowire devices on a CdTe substrate. These nanowires are predicted to host Majorana zero modes. We demonstrate the compatibility of the rf technique, including both resistive and capacitive sensing, with these nanowires. The effect of dielectric loss from the CdTe substrate is quantitatively characterized. Furthermore, the feasibility of rf reflectometry is verified under finite magnetic fields where zero-energy modes can emerge. Our results establish the fast control of PbTe quantum devices, paving the way for their applications in topological quantum computation.

09.
arXiv (CS.LG) 2026-06-25

Learning Optimization Proxies for Sequential Contextual Stochastic Programs: An Order Fulfillment Application

arXiv:2606.25362v1 Announce Type: cross Abstract: Sequential contextual stochastic programs model real-time decision systems in which each time epoch commits to an action under uncertainty whose consequences propagate into future decisions. In many practical contexts, these programs require obtaining solutions rapidly as new information becomes available. These problems can be represented through scenario approximations to be solved by off-the-shelf optimization solvers, which achieve high decision quality offline but typically run in seconds to minutes per instance, falling short of the sub-second responses that peak periods of planning require. This paper develops a learning-based optimization proxy: a scenario-embedded neural network trained offline on solver-generated labels, paired online with a decoder that enforces feasibility, replacing the per-epoch solve with a single forward pass. The framework is specialized to omnichannel order fulfillment, where each arriving order requires a sub-second assignment of products to distribution centers and carrier services under stochastic delivery times and future demand. A two-stage contextual stochastic program is introduced to formulate this problem, and its contextual sample average approximation (C-SAA) supplies the offline labels, while a composite training loss combines label imitation, a constraint-violation penalty, and self-supervised cost alignment. In a calibrated simulator built from JD.com transactional records, a detailed computational study is provided. The proxy reduces decision latency by roughly 2800x relative to the online finite-sample C-SAA reference and improves over it by 3.3% in realized fulfillment cost. Relative to established fulfillment policies, the proxy lowers total realized cost by at least 10.7% and roughly halves the late-delivery rate.

10.
arXiv (CS.AI) 2026-06-16

Resilient Consensus in Agentic AI

arXiv:2606.15024v1 Announce Type: cross Abstract: Large language model (LLM) agents are increasingly deployed in multi-agent systems where they must coordinate and agree on shared decisions. We ask whether classical resilient consensus theory, developed for deterministic agents, transfers to LLM agents that may behave adversarially. Framing LLM agreement as a Byzantine consensus game, we run controlled experiments on complete and general communication graphs. We find that prompted LLM agents fail to reach agreement that is achievable in principle: consensus can fail even in settings where classical theory guarantees that a convergent algorithm exists, and this failure persists across temperatures and horizons. At the same time, wrapping the agents with classical resilient consensus filters improves agreement. The benefit of filtering depends on how much robustness the underlying topology already provides. Our results suggest that classical resilient consensus theory is a useful lens for the safety of agentic AI.

11.
Nature (Science) 2026-06-25

How long-term dietary cholesterol can slow down its own clearance by liver cells

作者: 未知作者

Cholesterol carried by low-density lipoprotein (LDL) drives heart disease and is cleared by liver cells expressing the receptor LDLR. A cell-signalling mechanism has been discovered through which high cholesterol promotes the enzyme-mediated degradation of LDLR. Blocking this enzyme restores LDLR levels in liver cells, suggesting a new strategy for treating high cholesterol. Chronic exposure to cholesterol can move the receptor protein LDLR into cells for degradation.

12.
arXiv (CS.AI) 2026-06-18

Scalable Batch Bayesian Optimization Via Subspace Acquisition Functions

arXiv:2411.16206v3 Announce Type: replace-cross Abstract: Extending Bayesian optimization to batch evaluation can enable the designer to make the most use of parallel computing technology. However, most of current batch approaches do not scale well with the batch size. That is, their optimization efficiencies often deteriorate as the batch size increases. To address this issue, we propose a simple and efficient approach to extend Bayesian optimization to large-scale batch evaluation in this work. Different from existing batch approaches, the idea of the new approach is to draw a batch of axis-aligned subspaces of the original problem and select one point from each subspace using existing acquisition functions. Numerical experiments show that our proposed approach speedups the convergence significantly when compared with the sequential Bayesian optimization algorithm, and performs very competitively when compared with ten batch Bayesian optimization algorithms. The implementation of our proposed approach is available at https://github.com/zhandawei/SubSpace_Acquisition_Functions.

13.
arXiv (math.PR) 2026-06-11

Instability of a nonlinear oscillator with small friction and small additive noise

arXiv:2606.11389v1 Announce Type: new Abstract: Let $\lambda = \lambda(\beta,\sigma,a,b)$ denote the top Lyapunov exponent for the linearization along trajectories of the noisy damped non-linear oscillator $\ddot{x}+\beta \dot{x} + ax+bx^3 = \sigma \dot{W}_t$, where $a$, $b$ and $\beta$ are all positive and $\sigma \neq 0$. In 2004 Arnold, Imkeller and Sri Namachchivaya stated without proof that $\lambda(\varepsilon^2 \beta,\varepsilon \sigma,a,b) \sim \overline{\lambda} \varepsilon^{2/3}$ as $\varepsilon \to 0$ with $\overline{\lambda} > 0$. This paper contains a proof of this assertion.

14.
PLOS Medicine 2026-06-01

The NIH 2025 Public Access Policy: Immediate access, unequal costs

by Caitlin R. Ryus, Caroline Raymond King, Edward R. Melnick The NIH 2025 Public Access Policy eliminates embargo periods for federally funded research, expanding who can read science. Yet without addressing article processing charges and market concentration, the policy risks creating new barriers to who can afford to perform and publish their science. In this Perspective, Caitlin Ryus and colleagues discuss the NIH 2025 Public Access Policy, highlighting that while expanding who can read science, the policy risks creating new barriers to who can afford to perform and publish their science.

15.
arXiv (quant-ph) 2026-06-19

Purity and bound energy in ancilla-assisted work extraction

arXiv:2606.19945v1 Announce Type: new Abstract: We investigate ancilla-assisted work extraction in quantum batteries from the perspective of bound energy and purity. We show that the bound energy of the reduced system provides a tight upper bound to the daemonic gain and that this bound is saturated for globally pure system–ancilla states. Motivated by this relation, we introduce a purity-based gain that qualitatively predicts the daemonic gain without requiring explicit optimization over measurements. We further introduce a protocol to analyze the role of dissipation and intrinsic interactions on daemonic gain. Under a collective environment, dissipation can dynamically generate and stabilize finite daemonic gain through environment-induced correlations. In interacting systems, level crossings and spectral restructuring strongly modify the attainable gain through their influence on the accessible bound energy. Our results demonstrate that daemonic gain is governed not only by correlations, but also by the spectral structure of the underlying Hamiltonian and information loss captured by bound energy and purity.

16.
arXiv (CS.CV) 2026-06-18

Revealing Hidden Vulnerabilities in Autoencoders through Gradient Signal Restoration

Adversarial robustness of deep autoencoders (AEs) has received less attention than that of discriminative models, although their compressed latent representations induce ill-conditioned mappings that can amplify small input perturbations and destabilize reconstructions. Existing white-box attacks for AEs, which optimize norm-bounded adversarial perturbations to maximize reconstruction damage, often converge to suboptimal perturbations, thereby potentially overstating AE robustness. We show that this limitation is linked to vanishing adversarial loss gradients during backpropagation through ill-conditioned layers, associated with near-zero singular values in their intermediate weight matrices. To address this, we propose GRILL (Gradient Signal Restoration in Ill-Conditioned Layers), a framework designed to mitigate gradient degradation and improve the reliability of adversarial robustness evaluation in encoder-decoder architectures. GRILL is designed to mitigate adversarial gradient degradation during optimization, enabling attacks to better approximate high-distortion perturbations under fixed norm constraints. Through extensive experiments across multiple AE architectures, under both sample-specific and universal attacks, as well as standard and adaptive attack settings, we show that GRILL significantly increases attack effectiveness, thereby exposing vulnerabilities hidden by existing attack limitations. Beyond AEs, we provide preliminary evidence that modern multimodal encoder-decoder architectures exhibit similar vulnerabilities.

17.
arXiv (CS.AI) 2026-06-24

Breaking the Filter Bubble: A Semantic Pareto-DQN Framework for Multi-Objective Recommendation

arXiv:2606.24042v1 Announce Type: new Abstract: Recommender systems often induce filter bubbles and semantic homogenization by monolithically optimizing for immediate user engagement. Standard single-objective models, including traditional Deep Q-Networks, are ill-equipped to navigate the trade-offs between platform retention and critical societal values like information diversity and provider fairness. To address these limitations, we introduce a multi-objective reinforcement learning framework that formalizes recommendation as a semantic multi-objective Markov decision process. By integrating high-fidelity semantic embeddings with a Pareto-DQN agent, our architecture treats engagement, diversity, and fairness as distinct, non-aggregable reward signals, avoiding the pitfalls of static reward scalarization. Empirical evaluations on the MovieLens small dataset shows that our hypervolume based action selection disrupts the feedback loops responsible for semantic collapse. By sustaining high state-trajectory variance, the Pareto-DQN effectively maps the Pareto frontier, achieving gains in auxiliary societal objectives with only marginal impacts on engagement. This work provides a path toward intrinsically aligned, responsible recommender systems.

18.
arXiv (CS.AI) 2026-06-11

Towards Deep Learning Surrogate for the Forward Problem in Electrocardiology: A Scalable Alternative to Physics-Based Models

arXiv:2512.13765v2 Announce Type: replace-cross Abstract: The forward problem in electrocardiology, computing body surface potentials from cardiac electrical activity, is traditionally solved using physics-based models such as the bidomain or monodomain equations. While accurate, these approaches are computationally expensive, limiting their use in real-time and large-scale clinical applications. We propose a proof-of-concept deep learning (DL) framework as an efficient surrogate for forward solvers. The model adopts a time-dependent, attention-based sequence-to-sequence architecture to predict electrocardiogram (ECG) signals from cardiac voltage propagation maps. A hybrid loss combining Huber loss with a spectral entropy term was introduced to preserve both temporal and frequency-domain fidelity. Using 2D tissue simulations incorporating healthy, fibrotic, and gap junction-remodelled conditions, the model achieved high accuracy (mean $R^2 = 0.99 \pm 0.01$). Ablation studies confirmed the contributions of convolutional encoders, time-aware attention, and spectral entropy loss. These findings highlight DL as a scalable, cost-effective alternative to physics-based solvers, with potential for clinical and digital twin applications.

19.
arXiv (CS.AI) 2026-06-17

FinAcumen: Financial Multimodal Reasoning via Self-Evolving Experience Memory Harness

arXiv:2606.17642v1 Announce Type: new Abstract: Financial multimodal reasoning requires agents to coordinate numerical computation, retrieval, visual interpretation, and temporal grounding across heterogeneous evidence sources. Existing tool-augmented agents improve execution fidelity, yet remain largely stateless across episodes, repeatedly rediscovering reasoning strategies and failure patterns. In high-stakes financial settings, this leads to unreliable tool routing, noisy retrieval, and hallucination-prone reasoning. We present FinAcumen, a financial reasoning agent framework centered on selective experience memory for tool-augmented multimodal reasoning. FinAcumen accumulates financially grounded reasoning experience from prior trajectories, distilling successful strategies and failure-derived cautionary rules into a persistent memory bank. During inference, retrieved experiences condition reasoning only when semantic relevance exceeds a calibrated threshold, while irrelevant memory is explicitly suppressed through a fallback mechanism. A deterministic financial tool environment further grounds numerical computation, retrieval, visual decoding, and answer verification.Across four financial multimodal reasoning benchmarks, FinAcumen consistently improves a frozen 8B vision-language model over finance-specialized models and approaches leading proprietary general-purpose models. Further analysis shows that selective experience activation improves reasoning reliability under retrieval uncertainty. Our code is anonymously available at https://anonymous.4open.science/r/FinAcumen

20.
arXiv (CS.CV) 2026-06-16

HairLRM: Strand-based Hair Modeling via Large Reconstruction Models

The fundamental limitation of traditional strand-based modeling is not simply data scarcity, but the ill-posedness of inferring complex 3D fields from 2D imagery without structural constraints. This unconstrained regression leads to catastrophic failures in resolving both global occlusion (e.g., in ponytails) and local directionality (e.g., in curls), resulting in over-smoothed, plausible-but-incorrect geometries. To resolve this, we integrate the strong geometric priors of Large Reconstruction Models (LRMs) into the strand generation pipeline. Using the LRM mesh as a structural anchor, we employ a novel Dual Orientation AutoEncoder to lift coarse geometry into high-fidelity strands. By resolving vector field singularities through latent-space optimization and surface-guided refinement, our method effectively disentangles complex topological structures, setting a new benchmark for robustness and accuracy in hair reconstruction.

22.
arXiv (CS.AI) 2026-06-16

RaBiT: Residual-Aware Binarization Training for Accurate and Efficient LLMs

arXiv:2602.05367v3 Announce Type: replace Abstract: Efficient deployment of large language models (LLMs) requires extreme quantization, forcing a critical trade-off between low-bit efficiency and performance. Residual binarization enables hardware-friendly, matmul-free inference by stacking binary ($\pm$1) layers, but is plagued by pathological feature co-adaptation. We identify a key failure mode, which we term inter-path adaptation: during quantization-aware training (QAT), parallel residual binary paths learn redundant features, degrading the error-compensation structure and limiting the expressive capacity of the model. While prior work relies on heuristic workarounds (e.g., path freezing) that constrain the solution space, we propose RaBiT, a novel quantization framework that resolves co-adaptation by algorithmically enforcing a residual hierarchy. Its core mechanism sequentially derives each binary path from a single shared full-precision weight, which ensures that every path corrects the error of the preceding one. This process is stabilized by a robust initialization that prioritizes functional preservation over mere weight approximation. RaBiT redefines the 2-bit accuracy-efficiency frontier: it achieves state-of-the-art performance, rivals even hardware-intensive Vector Quantization (VQ) methods, and delivers a $4.49\times$ inference speed-up over full-precision models on an RTX 4090. Code is available at https://github.com/SamsungLabs/RaBiT.

23.
arXiv (CS.AI) 2026-06-11

LUCID: Learning Embodiment-Agnostic Intent Models from Unstructured Human Videos for Scalable Dexterous Robot Skill Acquisition

arXiv:2606.11628v1 Announce Type: cross Abstract: The most widely-adopted robot learning pipelines today learn skills from robot demonstrations or structured human data, which are expensive to collect and tied to specific embodiments. In contrast, unstructured human videos provide a scalable alternative. They contain diverse manipulation demonstrations across objects, scenes, and strategies, but are not directly connected to robot action. We propose LUCID, a two-stage framework that learns task intent from unstructured human videos drawn from internet-scale datasets and learns robot control in massively-parallel simulation. The intent model predicts short-horizon intent (what should happen next in the scene) from the current observation in closed loop. An embodiment-specific sensorimotor policy converts this intent into robot actions. The intent interface is shared across controllers, so the same intent model can be applied to different embodiments, from our primary dexterous hand to a parallel-jaw gripper. We evaluate LUCID on five real-world manipulation tasks: stirring, wiping, and binning supervised by only internet video, with zero-shot transfer to novel scenes and object instances; and push-T and cable routing supervised by 1 hr each of self-collected smartphone video. Project page: https://lucid-robot.github.io/.

24.
medRxiv (Medicine) 2026-06-24

Pre-activity glycemic prediction prioritizes post-meal movement

Post-meal activity can attenuate glucose excursions; however, the exact magnitude of this effect remains unquantified, and guidance is rarely personalized to the meal occasion. We linked Human Phenotype Project diet logs, continuous glucose monitoring and wearable step counts to test whether glycemic risk estimated before activity occurs can prioritize post-meal movement. An activity-blind PPGR model trained on 391,214 PPGR-valid meals from 9,561 participants generated pre-activity meal scores. Among 55,949 step-linked meals from 1,627 adults without diabetes, higher 0-120-min post-meal steps were associated with lower within-participant PPGR (-53.0 mg/dL*min per 1 s.d. higher log steps; 95% CI, -64.2 to -41.7), with larger adjusted PPGR iAUC contrasts at 1,501-2,500 observed steps (-154.4 mg/dL*min versus 0-50 steps). Associations were stronger among participants with higher glycemic-adiposity burden and after meals with higher predicted PPGR. A held-out pre-activity step-response ranking concentrated larger inverse step-PPGR associations (-79.1 top versus -15.0 mg/dL*min bottom quintile), providing a testable strategy for prediction-guided, post-meal movement prompts.

25.
medRxiv (Medicine) 2026-06-18

Effectiveness and Safety of Bempedoic Acid Across Clinically Relevant Subgroups: Insights from the CLEAR Taiwan Study

Background Despite available lipid-lowering therapies (LLT), many patients fail to achieve low-density lipoprotein cholesterol (LDL-C) targets. This gap persists across clinically relevant subgroups. Bempedoic acid has demonstrated effective LDL-C lowering with a favorable safety profile in the CLEAR Taiwan study; however, its effects across subgroups in Asian populations remains limited. Methods The phase IV CLEAR Taiwan study (NCT06925100) enrolled patients with inadequately controlled hypercholesterolemia who received bempedoic acid for 12 weeks in addition to background LLT. This analysis evaluated changes in lipid parameters, high-sensitivity C-reactive protein (hsCRP), and safety outcomes in clinically relevant subgroups, including cardiovascular risk, diabetes, age, statin tolerance, and sex. Results A total of 180 patients were included. Bempedoic acid achieved significant LDL-C reductions in all subgroups. Numerically greater LDL-C reductions were observed in primary prevention, statin-intolerant, younger (< 65 years), and female patients, while comparable reductions were observed across diabetes status. Reductions in non-high-density lipoprotein cholesterol, total cholesterol, and apolipoprotein B were consistent with LDL-C findings. Significant decreases in hsCRP were observed in all subgroups, with numerically greater reductions in patients aged < 65 years and those without diabetes. Bempedoic acid was well tolerated, with a low incidence of adverse events and no new safety signals identified. Changes in liver enzymes, renal function, and uric acid were minimal within subgroups. Conclusion Subgroup analyses from the CLEAR Taiwan study demonstrate consistent efficacy and safety of bempedoic acid across clinically relevant subgroups and support its use as a flexible option to address residual gaps in lipid management.