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Objective: To systematically evaluate the relationship between saxagliptin and risk of cardiac failure in type 2 diabetes patients. Methods: All the related literature was retrieved from the databases such as China Science and Technology Journal Database (VIP), Wanfang Data Digitalization Journals, China National Knowledge Infrastructure (CNKI), PubMed and Cochrane library from the inception to December 2017. The randomized controlled trails (RCTs) about cardiac failure induced by saxagliptin in type 2 diabetes patients were collected, the data was screened and the quality of the included RCTs was assessed. Then, meta analysis was performed using RevMan 5.3 software. Results: A total of 11 RCTs were included. Meta-analysis showed that saxagliptin caused higher risk of cardiac failure than that in the control group (RR=1.20, 95% CI 1.02 to 1.42, P=0.03). Further research revealed that 5 mg/d saxagliptin monotherapy or combined therapy also induced higher risk of car-diac failure than that in the control group [RR=1.24, 95% CI (1.05, 1.46), P=0.01]. However, 2.5 or 10 mg/d saxagliptin, regardless of monotherapy or combined therapy, had similar risk of cardiac failure as the control group [2.5 mg/d saxagliptin RR=0.69, 95% CI (0.31, 1.55), P=0.37; 10 mg/d saxagliptin RR=0.18, 95% CI (0.02, 1.67), P=0.13]. Conclusion: Saxagliptin at a dose of 5 mg/d may increase risk of cardiac failure, while other doses of saxagliptin are not correlated with the increased risk of cardiac failure. However, its long-term safety still remans to be confirmed by more high-quality, large-sample RCTs with long-term follow-ups. [ABSTRACT FROM AUTHOR]