To investigate the relationship between the ratio of non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) and the risk of one-year stroke recurrence in elderly patients with mild acute ischemic stroke (AIS). Methods: Through the Xi’an Stroke Registry Research database, we continuously collected patients’total cholesterol, HDL-C, and related clinical information at the time of admission, as well as follow-up data on recurrent stroke events at 3, 6, and 12 months after diagnosis. Non-HDL-C was calculated by subtracting HDL-C from total cholesterol. The non-HDL-C/HDL-C ratio was analyzed both as a continuous variable and as quartile groups (Q1～Q4). Multivariate Cox regression analysis was used to explore the relationship between the non-HDL-C/HDL-C ratio and the risk of one-year stroke recurrence in elderly patients with mild AIS. The Kaplan-Meier method was employed to analyze one-year stroke recurrence for different non-HDL-C/HDL-C ratios. Results: A total of 826 elderly patients with mild AIS were included in the study. After adjusting for relevant confounding factors, multivariate Cox regression analysis revealed that for each unit increase in the non-HDL-C/HDL-C ratio, the risk of one-year stroke recurrence increased by 54% (HR=1.54, 95%CI 1.15～2.07, P=0.004). Compared to the Q1 group, the risk of one-year stroke recurrence was 2.27 times higher in the Q4 group (HR=3.27, 95%CI 1.21～8.81, P=0.019), while there was no statistically significant difference in the risk of one-year stroke recurrence between other groups (Q2 and Q3) and Q1. The trend test showed a significant statistical increase in one-year recurrence risk from Q1 to Q4 groups (trend test P=0.004). Curve fitting analysis indicated that as the non-HDL-C/HDL-C ratio increased, the risk of one-year stroke recurrence gradually rose. K-M survival analysis of the quartiles found that compared to other groups, the one-year stroke recurrence rate was significantly higher in the Q4 group (≥3.58). Conclusion: An elevated non-HDL-C/HDL-C ratio is probably an independent risk factor for one-year stroke recurrence in elder- ly patient with mild AIS, and a ratio ≥3.58 significantly increases the risk of one-year stroke recurrence in these patients.