Health coaching is an effective strategy for improving cardiovascular disease risk factors. Coaching interventions have primarily been studied in Caucasians, and the effectiveness in other ethnic groups is not known. Further, adaptation of coaching to include culturally specific components has not been studied. Our aim is to describe a culturally specific coaching program targeted at reducing cardiovascular disease risk in South Asians. Participants initially underwent comprehensive cardiovascular disease risk screening, then received individualized risk assessment and behavioral recommendations. A health coach then contacted participants regularly for one year to provide encouragement with behavior change, troubleshoot challenges, and assess adherence. In the first five years of the program, 3,180 people underwent risk assessment, 3,132 were candidates for coaching, 2,726 indicated a desire to participate in coaching, 1,359 received coaching, and 1,051 completed coaching for at least one year. Culturally specific health coaching is an appealing and feasible intervention for reducing cardiovascular disease risk in South Asians, with very low attrition. Coaching strategies for risk reduction are proven to be effective, but further longitudinal research is needed to determine whether the impact of incorporating cultural specificity improves the effectiveness. This program utilizes non-medically trained personnel as coaches and is relatively inexpensive, with potential for great cost savings in prevention of cardiovascular disease.