() infection is prevalent in 42-64% of the Chinese population, with emerging evidence linking it to extragastrointestinal diseases, including stroke. This study aimed to investigate the association between infection and lipid metabolism, inflammatory markers, and the modified Framingham stroke risk score in patients at high risk of ischemic stroke, and to further analyze the relationship between the Framingham risk score and related clinical variables. A retrospective analysis was performed on 320 patients at high risk of ischemic stroke (10-year stroke risk ≥10% by modified Framingham scale) admitted to Jinhua People's Hospital from January 2020 to December 2022. Patients were divided into a -positive group ( = 180) and a -negative group ( = 140) based on C urea breath test (≥100 dpm/mmol vs. <100 dpm/mmol). Clinical data, lipid profiles (total cholesterol [TC], triglycerides [TG], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C]), inflammatory markers (high-sensitivity C-reactive protein [hs-CRP], homocysteine [Hcy], fibrinogen [FIB]), and modified Framingham stroke risk scores were compared between groups. Correlation and multivariate regression analyses were used to explore the relationships between variables. Compared with the -negative group, the -positive group had significantly higher levels of TC, TG, LDL-C, hs-CRP, Hcy, FIB, and modified Framingham scores (all < 0.05), and lower HDL-C ( < 0.05). infection correlated positively with the modified Framingham stroke risk score (point-biserial = 0.33, < 0.001). Multivariate regression showed that infection was an independent predictor of elevated modified Framingham stroke risk scores (β = 0.21, < 0.001). infection is associated with abnormal lipid metabolism, enhanced inflammatory response, and increased ischemic stroke risk in high-risk patients, suggesting its potential role in stroke pathogenesis.