Objective <p>Stroke-associated pneumonia (SAP) is relevant to the poor functional outcomes of patients with spontaneous intracerebral hemorrhage (SICH). It is unclear if the triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) ratio (TG/HDL-C) is related to the risk of SAP in SICH patients. This study aimed to investigate the association between TG/HDL-C and SAP in SICH patients.</p> Methods <p>Consecutive patients with SICH were enrolled in this retrospective study. Relevant clinical variables were extracted from electronic medical records. All enrolled participants were divided into SAP (<i>n</i> = 71) and non-SAP (<i>n</i> = 187) groups. Multivariate binary logistic regression analysis was used to explore the association between TG/HDL-C and SAP. The optimal cutoff value of TG/HDL-C was defined by the receiver operating characteristic (ROC).</p> Results <p>Among 258 patients, 71 (27.5%) had SAP. Patients with SAP were older (72.75 ± 11.10 vs. 64.81 ± 12.70 years), with a lower TG, higher HDL-C, and lower TG/HDL-C than participants in the non-SAP group. TG/HDL-C was an independent protective factor for SAP (adjusted OR 0.516, 95% CI 0.339–0.784) after adjusting for relevant risk factors. According to ROC analysis, the optimal cutoff value was a TG/HDL-C &gt; 1.09 for decreased SAP [area under the ROC curve (AUC) 0.705; sensitivity 76.1% and specificity 59.4%]. Patients with a TG/HDL-C of &gt; 1.09 were independently associated with decreased SAP (adjusted OR 0.285, 95% CI 0.138–0.591 ) after adjustment.</p> Conclusion <p>This study suggests that a lower TG/HDL-C is independently associated with increased SAP after SICH.</p>