OBJECTIVES: To assess the Incidence, the pattern of occurrence, risk factors for Sulphonulurea (SU) induced cardiovascular events (CE) in comparison with non sulphonylureas in diabetic patients (DPs). METHODS: The prospective study was conducted at south indian Hospital with Institutional ethical approval. The DPs with SU use, admitted with or without CE like Myocardial Infarction (MI), Unstable Angina (UA), Congestive Heart Failure (CHF) were recruited. Patients were divided into 2 groups, DPs with cardiovascular events (cases) and diabetic patients without CE(control). Risk factors for CE like lipid profile, social habits, like smoking, alcoholism, hypertension, BMI were also recorded. MI was defined as per International Classification of disease, Clinical Modification (ICD-10-CM code 121). UA was defined according to ICD-10-CM code 120. The CHF was defined according to ICD-10-CM code 150. RESULTS: A total of 600 DPs were enrolled in the study. Out of which 300 patients were diabetic with CE (cases) and 300 were diabetic without CE (control). Majority of the population was on SU 54.5% and SU use were highest in cases 58.7% compared with control group 50.3%, Statistical Chi Square test showed P value < 0.05 (0.04) showing a statistically significant difference between case and control population. Out of 300 patients 42% were with UA, 53% were with acute MI and 5% were with CHF. Event rate of acute MI (0.53%) were observed highest followed by UA (0.42) and CHF (0.05) respectively. Among SU, glimepiride (47%) was the most commonly used sulphonylurea alone, metformin combination (34%) followed by glibenclamide 5%, gliclazide 3% and glipizide <1%. SU use has showen higher incidence of MI 29%, compared to UA 22% and CHF 3% in our study. CONCLUSIONS: Clinicians must be cautious with the use of long term sulphonylureas especially in diabetic patients with cardiovascular risks.