The study analyzed the association of PCSK9 inhibitors with neurological adverse effects using the FAERS database and real-world data from 1,203 Chinese patients with coronary heart disease. 173,622 reports involving at least one PCSK9 inhibitor were identified in FAERS from Q3 2015 to Q2 2025. Statistically significant signals included memory impairment (n=1346, ROR=1.48, 95% CI 1.4–1.56), headache (n=190, ROR=1.46, 95% CI 1.26–1.68), sinus headache (n=65, ROR=2.38, 95% CI 1.86–3.04) and occlusion. carotid artery (ROR=2.36–4.02, 95% CI). Disproportionality analysis used ROR, IC, BayR and BCPNN methods with Bonferroni correction. Real-world follow-up data showed that patients with PCSK9 inhibitors had a significantly higher incidence of memory impairment (p<0.0001) and headache (p=0.0027) than patients without them. The findings can help create individualized treatment plans.