Introduction: Cardiovascular disease (coronary artery disease and stroke, CVD) is a major health risk among the South Asian diaspora in the US. Factors like genetics and acculturation can influence the onset and progression of these diseases. Our study investigated the associations of acculturation and family history with CVD and a major CVD risk factor of hypertension (HTN) in US South Asians. Methods: We surveyed 105 US South Asian adult participants recruited at a community event. Respondents provided information on acculturation (measured by the adoption of English spoken at home), and family history of CVD and HTN in parents and siblings. Prevalence of CVD and HTN were compared between those with or without factors of interest. Multivariate logistic regression models were run for family history variables of interest, adjusted for age, gender, and English speaking at home. Results: Participants had median age 54 (range 20-75) years, and 69.2% were male. The Table shows the association of parental and sibling history of CVD and hypertension with having CVD or HTN personally, and the association of home language with these conditions. Multivariate adjusted logistic regression analysis found little attenuation, in that , sibling history of CVD remained significantly associated with personal CVD (p = 0.026), parental history of HTN remained significantly associated with personal HTN (p=0.004) and sibling history of HTN remained significantly associated with personal HTN (p=0.014). Conclusion: Among South Asians in the US, family history in 1st degree relatives, rather than language acculturation, is associated with personal CVD and HTN, suggesting a genetic burden. The stronger association of sibling history rather than parental history of CVD suggests a possible role of environmental or secular factors that siblings may share more than parents and offspring. In this population at high risk of CVD, careful recording of family history may help early prevention strategies.