Objective To analyze the correlation between triglyceride glucose index (TyG) combined with different obesity indexes and new-onset ischemic stroke (IS) in 10 years in prediabetes population in Luzhou, Sichuan through cohort study. Methods A total of 2 551 residents who participated in the epidemiological survey in Luzhou in 2011 and were diagnosed as having prediabetes were enrolled. According to the quartiles of baseline TyG-waist circumference (WC), TyG-waist to height ratio (WtHR), TyG-body mass index (BMI), and TyG-waist to hip ratio (WHR), they were divided into the 1^st, 2^nd, 3^rd, and 4^th quartiles groups (Q1, Q2, Q3, and Q4 groups). The incidence of new-onset IS in each group in 10 years was analyzed. The relationships between TyG-WC, TyG-WtHR, TyG-WHR and new-onset IS were analyzed by multivariate logistic regression. Results Among the 2 551 prediabetes subjects enrolled in the study, 123 died of various causes during the 10 years of non-intervention follow-up, with a mortality of 4.8%; 142 had new-onset IS, with an incidence of 5.6%; and 224 had new-onset diabetes mellitus, including 22 also had new-onset IS, accounting for 9.8%. The quartile grouping analyses of TyG-WC and TyG-WtHR showed that the incidence of new-onset IS in prediabetes subjects over 10 years was Q4 group＞Q3 group＞Q2 group＞Q1 group, with significant differences (P＜0.05). The quartile grouping analysis of TyG-BMI showed that there was no significant difference in the incidence of new-onset IS (P＞0.05). The quartile grouping analysis of TyG-WHR showed that the incidence of new-onset IS was Q3 group＞Q4 group＞Q2 group＞Q1 group, with significant difference (P＜0.05). Multivariate logistic regression analysis showed that TyG-WtHR was associated with new-onset IS in prediabetes subjects, either without adjusting any variable or after adjusting multiple factors. Conclusion TyG-WtHR is a risk factor of IS in prediabetes individuals. Enhancing management of prediabetes patients with high TyG-WtHR may reduce the risk of IS.