OBJECTIVES: To examine the risk of hospitalization due to cardiovascular events associated with the use of dipeptidyl peptidase-4 (DPP-4) inhibitors, compared to other anti-diabetic agents, among diabetic patients. METHODS: Patients age >18 years and taking diabetes medication were identified in the IMS Lifelink Plus® database for the years 2006-2013. Cardiovascular events were defined as inpatient discharge diagnosis of heart failure, stroke and coronary heart disease occurring at least 30 days after initiation of therapy. Patients were continuously enrolled for 6 months prior and 24 months post the date of first antidiabetic prescription (‘index-date’). Patients with cardiovascular event in 6-month pre-index period were excluded. Patients were followed for 24 months post index-date. Patients with at-least 30 days of DPP-4 inhibitors as their starting therapy were identified as DPP-4 inhibitors users, while patients with at-least 30 days of any other anti-diabetic therapy and no DPP-4 inhibitors in the 24-month follow-up period were identified as other anti-diabetic users. Unadjusted and adjusted logistic regression models were employed to estimate the risk of cardiovascular-related hospitalizations for those on DPP-4 inhibitors, compared with those on other antidiabetic agents. The model was adjusted for demographics, comorbidities, and region of residence. RESULTS: The final sample consisted of 45,767 patients with mean age of 50.71 years and 55.15 % females. Of these, 1973 patients had DPP-4 inhibitors while 43,794 had other anti-diabetic therapy. At baseline 2.43% patients had hypertension, 36.06% had dyslipidemia and 28.63% had valve disorder. Patients taking DPP-4 inhibitors had an increased risk for having a cardiovascular event as compared with those on other anti-diabetic agents (unadjusted odds ratio:1.524, 95% confidence interval [CI]:1.131-2.056; adjusted odds ratio: 1.331, 95% CI: 0.985-1.799). CONCLUSIONS: DPP4 inhibitors may increase the risk of cardiovascular events as compared to other anti-diabetic agents, which warrants close monitoring of diabetic patients on DPP-4 inhibitors.