There is a strong association between lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) levels and atherosclerosis-related diseases. The aim of this study was to investigate the role of Lp-PLA(2) in the ischemic stroke and further offer clinical evidence that measuring Lp-PLA(2) helps predict the risk of stroke occurrence and recurrence. A total of 328 hospitalized patients were recruited, including 179 cases of acute cerebral infarction (ACI) and 149 non-ACI controls. The serum level of Lp-PLA(2) in ACI was significantly higher than non-ACI. The serum level of Lp-PLA(2) in the recurrence of ACI was significantly higher than the nonrecurrence. The serum levels of Lp-PLA(2) in large-artery atherosclerosis subtype were the highest among the subtypes of the Trial of Org 10172 in Acute Stroke Treatment and non-ACI controls. The level of Lp-PLA(2) in large-artery atherosclerosis and the cardioembolism group was statistically significantly higher than that of the control cases. There was no statistically significant difference between the small-vessel occlusion group and the control cases. The present study confirmed that the elevated Lp-PLA(2) level can be a risk factor for ischemic stroke in the Chinese population. The serum level of Lp-PLA(2) may be a predictive factor for the recurrence of ACI.