T cells and B cells play substantial roles in the process of coronary artery disease (CAD). Here, we examined the role of circulating follicular helper T (Tfh) cells in CAD. Compared to non-CAD controls, CAD patients had increased levels of circulating Tfh. Also, circulating Tfh in CAD patients exhibited increased frequencies of Th1- and Th17-like phenotypes and aberrant cytokine expressions. Coculture experiments with B cells showed that Tfh from CAD patients were more potent at inducing antibody production from B cells, enhancing plasmablast differentiation and suppressing B10 cell differentiation. Importantly, we found that the skewing of circulating Tfh toward the Th1/Th17-like cells was directly correlated with B cell inflammation and low density lipoprotein level in CAD patients. Together, our data demonstrated a skewing of blood Tfh composition in CAD patients, which resulted in significant changes in B cell inflammation.