BackgroundIn recent years, there has been substantial research evaluating the relationship between arachidonate 5-lipoxygenase-activating protein (ALOX5AP) polymorphisms and ischemic stroke (IS). The objective of this study was to systematically review and analyze the existing evidence.MethodsA comprehensive search of major electronic databases for studies published between 1990 and 2018 was carried out. Data were synthesized as OR and 95% CI using fixed-effects and random-effects models.ResultsA total of 30 studies were available for analysis. The aggregate sample size across all studies was 32,782 (16,294 cases and 16,488 controls). We found no association of the ALOX5AP rs10507391 (OR=1.03 for A allele vs T allele; 95% CI: 0.93–1.14; P=0.557), rs4769874 (OR=1.13 for A allele vs G allele; 95% CI: 1.00–1.28; P=0.050), rs9551963 (OR=1.03 for A allele vs C allele; 95% CI: 0.96–1.11; P=0.372), rs17222814 (OR=1.09 for A allele vs G allele; 95% CI: 0.96–1.24; P=0.195), rs17222919 (OR=0.89 for G allele vs T allele; 95% CI: 0.75–1.06; P=0.175), and rs4073259 (OR=1.20 for A allele vs G allele; 95% CI: 1.00–1.45; P=0.056) polymorphisms with IS risk. Haplotype analysis also did not yield significant findings for the HapA (rs17222814G–rs10507391T–rs4769874G–rs9551963A; OR=1.20; 95% CI: 0.91–1.56; P=0.192) and HapB (rs17216473A–rs10507391A–rs9315050A–rs17222842G; OR=1.11; 95% CI: 0.90–1.38; P=0.339) haplotypes.ConclusionCurrent evidence does not support an association of rs10507391, rs4769874, rs9551963, rs17222814, rs17222919, rs4073259, and HapA and HapB with IS risk.