Objective To analyze the effect of alirocumab combined with ezetimibe in the treatment of acute cerebral infarction complicated by hyperlipidemia in the elderly.Methods The clinical data of 138 elderly patients with acute cerebral infarction complicated by hyperlipidemia admitted to our hospitals during January 2022 to December 2023 were retrospectively analyzed. According to different treatment methods, they were divided into the control group (n = 70, ezetimibe) and the observation group (n = 68, ezetimibe plus alirocumab). The clinical efficacy and adverse reactions were evaluated after 2 months of treatment. The National Institutes of Health Stroke Scale (NIHSS) scores, and levels of blood lipids and neurological indicators [non-high-density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (ApoB), apolipoprotein A1 (ApoA1), S100β protein] were measured before and after treatment.Results The overall effective rate in the observation group (98.53%) was higher than that of the control group (88.57%) (P < 0.05). The differences in NIHSS scores and levels of non-HDL-C, ApoB, ApoA1 and S100β protein before and after treatment in the observation group were all higher than those in the control group (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the observation group (16.18%) and the control group (11.43%) (P > 0.05).Conclusion Alirocumab combined with ezetimibe shows significant efficacy in treating elderly patients with acute cerebral infarction complicated by hyperlipidemia. It improves lipid metabolism and promotes neurological recovery with a high safety profile.