Background: The significance of cTfh cells and their subsets in atherosclerosis is not well understood. We measured the frequency of cTfh subsets in patients with different degrees of stenosis using flow-cytometry. Methods: Participants included high (≥50%; n = 12) and low (<50%; n = 12) stenosis groups, as well as healthy controls (n = 6). Results: The frequency of CCR7loPD-1hiefficient-cTfh was significantly higher in patients with high stenosis compared to healthy controls ( p = 0.003) and correlated with LDL ( p = 0.043), cholesterol ( p = 0.043), triglyceride ( p = 0.019), neutrophil count ( p = 0.032), platelet count ( p = 0.024), NLR ( p = 0.046), and PLR ( p = 0.025) in high stenosis group. The frequency of CCR7hiPD-1lo quiescent-cTfh was higher in healthy controls compared to the high-stenosis group ( p = 0.001) and positively correlated with HDL ( p = 0.046). The frequency of efficient-cTfh cells was correlated with platelet count ( p = 0.043), NLR ( p = 0.036), and PLR ( p P = 0.035) in low-stenosis group, while that of quiescent-cTfh cells was negatively correlated with LDL ( p = 0.034), cholesterol ( p = 0.047), platelet count ( p = 0.032), and PLR ( p = 0.041). Conclusion: High percentages of cTfh and efficient-cTfh cells in patients with advanced atherosclerosis and their correlation with dyslipidemia and WBC counts suggests an ongoing cTfh subset deviation, towards efficient phenotype in the milieu of inflammation and altered lipid profile. Efficient cTfh cells have an effector phenotype and could in turn contribute to atherosclerosis progression.